Flu vaccine 2017-2018 … for those 65 and over

Please read the guidelines below. If you are 65 or over, you have a choice between the government provided vaccine, Fluviral, or a “high-dose” vaccine(Fluzone High-Dose) made by Sanofi (not government funded). The latter is slightly more effective (see diagram below). If you are under 65, you should be receiving the usual vaccine.

2017-2018 NACI GUIDELINES FOR FLU VACCINATION

Adults ≥65 years of age

Four types of vaccine are available for use in adults ≥65 years of age: standard dose TIV, high dose TIV, MF59-adjuvanted TIV, and QIV.

Choice of vaccine product for adults ≥65 years of age

In choosing a vaccine product, it is important to consider the relative burden of influenza disease caused by the various influenza subtypes (i.e., influenza A(H1N1), influenza A(H3N2) and influenza B) in this age group, as well as the efficacy, immunogenicity and safety profile of the available vaccines.

A study focusing on estimates of deaths associated with influenza in the USA has established that the average annual rate of influenza-associated deaths for adults aged ≥65 years was 17.0 deaths per 100,000 (range: 2.4–36.7). The study also states that deaths among persons aged ≥65 years accounted for 87.9% of the overall estimated average annual influenza-associated deaths with underlying pneumonia and influenza causes. When influenza-related deaths were estimated using underlying respiratory and circulatory causes, these estimates increased to 66.1 deaths per 100,000 (range: 8.0–121.1) and 89.4%, respectively.

Canadian surveillance data shows that hospitalization rates among individuals ≥65 years of age were higher during the 2014–2015 season, a season in which A(H3N2) circulation predominated and there was a vaccine mismatch with the circulating A(H3N2) strain, compared to the previous five influenza seasons and also compared to the 2012–2013 season when A(H3N2) also predominated. Similar to the hospitalization rates, death rates among seniors were highest in the 2014–2015 season compared to the previous five seasons and compared to the previous A(H3N2) season in 2012–2013. Deaths rates among other age groups were similar to or lower than the previous five influenza seasons. Laboratory detections over this same time period showed that influenza seasons predominated by Influenza subtype A(H3N2) disproportionally affected adults ≥65 years of age while seasons with greater A(H1N1) detections resulted in a higher prevalence of positive cases in younger age groups.

Based on the available evidence, NACI concludes that there is evidence that high dose TIV should provide superior protection compared with standard dose TIV for adults ≥65 years of age.

Considering the burden of disease associated with influenza A(H3N2) and the evidence of superior efficacy of high dose TIV compared to standard dose TIV, it appears that high dose TIV would provide the greatest benefit to the ≥65 years age group.

This high dose flu vaccine is not provided by our Ontario government. It can be purchased from the pharmacy or at my office for $80.